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Postoperative Pain Relief After Total Hip and Knee Replacement

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Postoperative Pain Relief After Total Hip and Knee Replacement Postoperative pain relief after total hip and knee replacement PhD thesis Karen Vestergård Andersen Faculty of Health Sciences University of Aarhus 2010 Postoperative pain relief after total hip and knee replacement PhD thesis Karen Vestergård Andersen Faculty of Health Sciences University of Aarhus Supervisors Kjeld Søballe, Professor, MD, DMSc Department of Orthopedics Aarhus University Hospital, Denmark Lone Nikolajsen Associated Professor, MD, PhD Department of Anesthesiology and Danish Pain Research Center Aarhus University Hospital, Denmark Evaluation committee Sten Rasmussen, Associate Professor, MD, PhD (chairman) Department of Orthopedics Aalborg Hospital – University Hospital of Aarhus, Denmark Narinder Rawal, Professor, MD, DMSc Department of Anesthesiology and Intensive Care Örebro University, Sweden Søren Solgaard, MD, DMSc Department of Orthopedics Hillerød Hospital, Denmark Public Defense of this PhD thesis The public defense is scheduled for June 11 th 2010. Location: Auditorium 1, Aarhus University Hospital, Aarhus Hospital, Tage Hansens Gade 2, DK-8000. Preface This thesis was carried out at the Department of Orthopedics, Aarhus University Hospital in the period 2006 ─ 2009. Part of the research was performed at the Department of Anesthesiology at Glostrup Hospital. I am greatly indebted to a number of persons who have made this work possible. First of all, I wish to thank all the patients who volunteered to participate in the trials and spent their valuable time. I wish to thank the care staff at Aarhus University Hospital and Glostrup Hospital, without their efforts in registration of data none of these studies would have been possible. Especially I wish to express my sincere gratitude to my two enthusiastic supervisors Professor Kjeld Søballe MD., D.M.Sc, and Associate Professor Lone Nikolajsen MD, PhD, for their valuable and skilful guidance and support. Associate Professor Niels Trolle Andersen, Lic. Scient, Department of Biostatistics is thanked for valuable guidance with statistics. I am also grateful to Birgitte V. Christensen, MD, for her help at Glostrup Hospital and her friendship. Secretary Tina Stenumgaard is thanked for her help with various subjects. I also, wish to thank my fellow PhD students in the research group for our valuable discussions to research meetings and especially my friend Mette Krintel Petersen, Cand.Scient.San., PhD for her support, advice and for her friendship. Finally, I would like to thank my family and friends for always supporting me. Most of all, my deepest gratitude goes to my best friend and partner Hans Jørgen Wolf Andersen for his support. Acknowledgements I received generous financial support from Aarhus Hospital, Aarhus University Hospital and Forskningsinitiativet Aarhus hospital, Aarhus University Hospital. Aarhus, 28 February 2010. Karen Vestergård Andersen I List of papers: I. Reduced hospital stay and narcotic consumption and improved mobilization with local and intraarticular infiltration after hip arthroplasty Karen V. Andersen, Mogens Pfeiffer-Jensen, Viggo Haraldsted, Kjeld Søballe. Acta Orthopaedica 2007; 78(2):180-186. II. A Randomized Controlled Trial of Local Infiltration Analgesia vs. Epidural Infusion for Total Knee Arthroplasty Karen V. Andersen, Marie Bak, Birgitte V. Christensen, Jørgen Harazuk, Niels A. Pedersen, Kjeld Søballe – Submitted to Acta Orthopaedica 2010. III. A comparison of participants and non-participants in a randomized controlled trial involving 156 patients scheduled for primary total knee arthroplasty Karen V. Andersen, Anne F. Christensen, Mette K. Petersen, Birgitte V. Christensen, Niels A. Pedersen, Kjeld Søballe – Submitted to Acta Orthopaedica 2010. II Contents 1. English summary................................................................................................................. 5 2. Danish summary ................................................................................................................. 7 3. Introduction.......................................................................................................................... 9 3.1 Total hip replacement surgery .................................................................................... 9 3.2 Total knee replacement surgery................................................................................ 10 Fast track surgery .............................................................................................................. 11 3.3 Postoperative analgesia .............................................................................................. 11 4. Aim of the thesis................................................................................................................ 16 5. Design ................................................................................................................................. 17 The Randomized Controlled Trial.............................................................................. 17 6. Materials & methods......................................................................................................... 19 Ethical issues ...................................................................................................................... 19 Patients................................................................................................................................ 19 Study I ............................................................................................................................. 19 Studies II and III ............................................................................................................ 20 Intervention........................................................................................................................ 21 Control and intervention groups study I................................................................... 21 Control and intervention group study II ................................................................... 23 Study III .......................................................................................................................... 24 Outcomes............................................................................................................................ 25 Outcome measures in study I to II.............................................................................. 25 Outcome study I ............................................................................................................ 26 Outcome study II........................................................................................................... 27 Outcome study III ......................................................................................................... 27 Statistics .............................................................................................................................. 28 Sample size ..................................................................................................................... 28 Statistical methods ........................................................................................................ 28 7. Results................................................................................................................................. 29 Study I ............................................................................................................................. 29 Study II............................................................................................................................ 30 Study III .......................................................................................................................... 32 8. Discussion........................................................................................................................... 34 Key findings ....................................................................................................................... 34 Consideration of possible mechanism and explanations ............................................ 34 Comparison with relevant findings from other studies .............................................. 34 Limitations.......................................................................................................................... 37 Selection bias.................................................................................................................. 38 Random allocation ........................................................................................................ 39 Blinding and information bias..................................................................................... 39 9. Conclusion.......................................................................................................................... 40 10. Perspectives and future research .................................................................................. 41 11. References......................................................................................................................... 42 Appendices............................................................................................................................. 50 Papers 1 to 3 ........................................................................................................................... 53 III Abbreviations In alphabetic order ASA American Society of Anesthesiology IA Intraarticular CAS Cumulated Ambulation Score EA Epidural
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